Tobacco usage in the home: a cross-sectional analysis of heated tobacco product (HTP) use and combustible tobacco smoking in Japan, 2023.

BACKGROUND: Heated tobacco product (HTP) use continues in Japan as the second most common product after cigarettes. While the health effects of HTPs and their secondhand emissions are not well-studied, the tobacco industry has actively marketed HTPs as a smokeless, health-conscious alternative to cigarettes to encourage home consumption. We investigated the prevalence of current tobacco product use and usage at home. METHODS: The present study conducted a cross-sectional analysis of data from the 2023 wave of a nationwide, Internet-based, self-reported survey. 29,354 individuals aged 16-74 were included in the analysis. We assessed the prevalence of current (past-30-day) use for HTPs, cigarettes, non-cigarette combustible tobacco, and dual (combustible plus HTP) use. The frequency of use (daily or more than monthly) in the home was calculated for both HTPs and combustible tobacco. Multivariable Poisson regression models were employed to identify factors associated with home usage. Adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were computed. All analyses were weighted to address the Internet-based sample's selectivity and yield nationally representative estimates. RESULTS: In 2023, the prevalence of current use was 12.4% (HTPs), 18.9% (cigarettes), 3.6% (non-cigarette combustible tobacco), and 7.4% (dual use). Among current users of any tobacco (N = 5,818), 49.8% reported daily tobacco usage within their homes, and 67.1% reported monthly or more frequent home usage. Compared to exclusive combustible tobacco smokers, exclusive HTP users exhibited higher prevalence of daily home usage (APR = 1.54; 95% CI = 1.43-1.67), as did dual users (APR = 1.10; 95% CI = 1.01-1.20). Daily home usage prevalence was notably higher for those without complete tobacco-free rules at home or workplaces, older individuals, and those with lower education levels. Those living with adult or child household member and current drinkers showed significantly lower daily home usage prevalence. CONCLUSION: Home usage was more common among HTP users than among combustible tobacco smokers. Ongoing efforts to assess and address the impact of indoor tobacco product use, including HTPs, on health are warranted. Regulatory and educational strategies should be considered to discourage tobacco consumption in both public and private spaces.

Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan.

BACKGROUND: While heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP use and airway obstruction after switching from cigarettes. METHOD: The study subjects were patients aged ≥20 years undergoing surgery from December 2021 to September 2022 who completed spirometry and reported tobacco (cigarette and HTP) use status during the preoperative assessment. Airway obstruction was defined as forced expiratory volume in 1 s to forced vital capacity ratio below the lower limit of normal. Current tobacco use was defined as past-30-day use. Multivariable Poisson regression analysis was performed to examine the associations between HTP use and airway obstruction by adjusting for demographic characteristics, lifetime cigarette smoking (pack-year) and duration of smoking cessation. RESULTS: Overall (N=2850, 55.4% women, mean age 62.4), 4.6% and 10.7% reported current HTP use and cigarette smoking, respectively. 16.8% had airway obstruction. Airway obstruction was more common among current HTP-only users (adjusted prevalence ratio (APR)=2.32), current cigarette-only smokers (APR=2.57) and current dual users (APR=2.82) than never-tobacco users. Among current tobacco users (N=398), the prevalence of airway obstruction was not significantly different between HTP-only users and cigarette-only smokers. Among former cigarette smokers (>30-day cigarette quitters) (N=1077), current HTP users had 1.42 times the increased prevalence of airway obstruction than never-HTP users after adjusting for cigarette pack-year; a stronger association was observed when the analysis was restricted to ≥5-year cigarette quitters (N=772) (APR=1.96, vs never HTP users). CONCLUSION: Current HTP use was associated with airway obstruction among patients with cancer who had completely switched from cigarettes even after quitting smoking for a long period. Patients should be routinely screened for HTP use and advised to quit any tobacco.

Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries.

INTRODUCTION: Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa. METHODS: This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls. RESULTS: Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30). CONCLUSIONS: The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.

Unavoidable exposure to secondhand smoke in indoor places: a cross-sectional comparison to the Health Japan 21 (second term) objectives, 2022.

BACKGROUND: The second term Health Japan 21 aims at eliminating unwanted exposure to secondhand smoke (SHS) in society; however, the ambiguity of the term "unwanted exposure" complicates the evaluation of the program. In this study, we examined SHS exposure that occurred despite the efforts to avoid it (i.e. unavoidable SHS exposure) as a proxy for "unwanted SHS exposure". METHODS: Individuals aged 16-74 responded to a nationwide, Internet-based, self-reported survey. Frequency (daily/≥monthly) of SHS exposure in the past month was assessed for specific places (home/car/restaurant/cafe/bar/workplace/school/pachinko parlor) and any place. Unavoidable SHS was identified when respondents always tried to avoid but were exposed to SHS. The observed prevalence was compared to the target of Health Japan 21 ("Eliminate unwanted SHS exposure", =0%). Analyses were weighted to account for the selectivity of the Internet-based sample. RESULTS: Among overall (N = 25,672), those who always tried to avoid SHS (N = 14,971), and never smokers of combustible tobacco who always tried to avoid SHS (N = 10,416), the prevalence of daily SHS exposure was 12.4%, 5.7%, and 4.2%; ≥monthly SHS exposure was 34.0%, 21.4%, and 17.5%, respectively. Among never smokers, the adjusted prevalence ratio (APR) of daily unavoidable SHS exposure was significantly high in adolescents (age 16-19) (APR = 4.97, vs. age 60-74), less-educated individuals (APR = 2.37, vs. ≥some college education), and heated tobacco product (HTP) users (APR = 8.27, vs. nonusers). Among never smokers, daily unavoidable SHS exposure was highest in the home (3.4%), workplaces (2.3%), and pachinko parlors (1.3%); ≥monthly unavoidable SHS exposure was highest in workplaces (11.4%), restaurants/cafes/bars (10.0%), and the home (7.6%). CONCLUSIONS: Daily unavoidable SHS exposure was disproportionately high among adolescents, less-educated individuals, and HTP users. The prevalence of unavoidable SHS exposure did not reach the national target in any of the assessed indoor places; home and workplace were the dominant sources of unavoidable SHS exposure. The lack of comprehensive smoke-free laws provides inadequate protection against SHS that cannot be complemented by individual efforts. The authorities must ensure smoke-free environments for all.

Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan.

BACKGROUND: Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse. METHODS: 7044 adults (≥20 years old) with at least two observations over three waves (2019-2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups. RESULTS: At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20-29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20-29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10). CONCLUSION: HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.

Patterns of staging, treatment, and mortality in gastric, colorectal, and lung cancer among older adults with and without preexisting dementia: a Japanese multicentre cohort study.

BACKGROUND: Little is known about dementia's impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia. METHODS: Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65-99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014-2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival. RESULTS: Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer. CONCLUSION: Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.

Minimum surgical volume to ensure 5-year survival probability for six cancer sites in Japan.

BACKGROUND: In Japan, the government designates hospitals specialized in cancer care, requiring them to perform 400 surgeries annually without requiring surgical volume per cancer site. This study aimed to estimate the site-specific minimum surgical volume per year based on its associations with 5-year survival probability. METHODS: The data of 64,402 patients who had undergone surgery for six types of cancers (including esophageal, stomach, colorectal, pancreatic, lung, and breast cancers) at designated cancer care hospitals in Osaka between 2007 and 2011 were analyzed. The hospitals were categorized by the average annual surgical volume per cancer type (e.g., 0-4, 5-9, 10-14…). We estimated the adjusted 5-year survival probability per surgical volume category using multivariable Cox proportional hazard regression. Furthermore, we identified inflection points for the trend of adjusted survival probability per increase of five surgical volumes using the joinpoint regression model and considered them as the suggested minimum surgical volume. RESULTS: The estimated minimum surgical volumes were 35-39, 20-25, 25-29, 10-14, 10-14, and 25-29 for esophageal, stomach, colorectal, pancreatic, lung, and breast cancers, respectively. The percentage change in the adjusted 5-year survival probability per increase of five surgical volumes before and after the suggested surgical volume were +2.23 and +0.39 for the esophagus, +9.68 and +0.34 for the stomach, +8.11 and +0.05 for the colorectum, +3.82 and +0.87 for the pancreas, +9.46 and +0.23 for the lung, and +1.27 and +0.03 for the breast. CONCLUSIONS: The suggested surgical volume based on the association with survival probability varies with cancer sites, some of which are close to the existing surgical volume standards used in Japan. These evidence-based minimum surgical volumes may help improve the quality of cancer surgeries.

Socioeconomic disparities in cancer survival: Relation to stage at diagnosis, treatment, and centralization of patients to accredited hospitals, 2005-2014, Japan.

BACKGROUND: Cancer survival varies by socioeconomic status in Japan. We examined the extent to which survival disparities are explained by factors relevant to cancer control measures (promoting early-stage detection, standardizing treatment, and centralizing patients to government-accredited cancer hospitals [ACHs]). METHODS: From the Osaka Cancer Registry, patients diagnosed with solid malignant tumors during 2005-2014 and aged 15-84 years (N = 376,077) were classified into quartiles using the Area Deprivation Index (ADI). Trends in inequalities were assessed for potentially associated factors: early-stage detection, treatment modality, and utilization of ACH (for first contact/diagnosis/treatment). 3-year all-cause survival was computed by the ADI quartile. Multivariable Cox regression models were used to assess survival disparities and their trends through a series of adjustment for the potentially associated factors. RESULTS: During 2005-2014, the most deprived ADI quartile had lower rates than the least deprived quartile for early-stage detection (42.6% vs. 48.7%); receipt of surgery (58.1% vs. 64.1%); and utilization of ACH (83.5% vs. 88.4%). While rate differences decreased for receipt of surgery and utilization of ACH (Annual Percent Change = -3.2 and - 11.9, respectively) over time, it remained unchanged for early-stage detection. During 2012-2014, the most deprived ADI quartile had lower 3-year survival than the least deprived (59.0% vs. 69.4%) and higher mortality (Hazard Ratio [HR] = 1.32, adjusted for case-mix): this attenuated with additional adjustment for stage at diagnosis (HR = 1.23); treatment modality (HR = 1.20); and utilization of ACH (HR = 1.19) CONCLUSIONS: Despite improvements in equalizing access to quality cancer care during 2005-2014, survival disparities remained. Interventions to reduce inequalities in early-stage detection could ameliorate such gaps.

Impact of coexisting diabetes on survival and risk of developing second primary cancer in diabetes patients receiving drug therapy: A multicenter retrospective cohort study of patients with cancer in Japan.

AIMS/INTRODUCTION: We investigated the association between coexisting diabetes at the time of cancer diagnosis, and the overall survival and incidence of second primary cancer in patients with cancer and receiving drug therapy for diabetes. MATERIALS AND METHODS: We used cancer registry and administrative data of patients diagnosed with cancer at designated cancer care hospitals in Osaka Prefecture between 2010 and 2015. The presence of diabetes was identified from the prescription records of antidiabetic drugs in Diagnosis Procedure Combination System data. After adjusting for patient characteristics, we compared overall survival between patients with cancer with coexisting diabetes and those without coexisting diabetes using the Cox proportional hazards model. In addition, the impact of coexisting diabetes on the risk of developing second primary cancer was evaluated using a competing risk analysis. RESULTS: Of the 131,701 patients with cancer included in the analysis, 6,135 (4.7%) had coexisting diabetes. The 5-year survival rates for patients with and without coexisting diabetes were 56.2% (95% confidence interval 54.8-57.6) and 72.7% (95% confidence interval 72.4-73.0), respectively. Coexisting diabetes was associated with a higher risk of developing second primary cancer (subdistribution hazard ratio 1.23; 95% confidence interval 1.08-1.41). In site-specific analysis, coexisting diabetes was associated with an increased risk for the development of second primary cancer of multiple myeloma, and cancer of the uterus, pancreas and liver. CONCLUSIONS: Coexisting diabetes was associated with a higher mortality and risk of developing second primary cancer in Japanese patients with cancer and on drug therapy for diabetes.

Incidence of second primary cancers among survivors of childhood cancer: A population-based study, Osaka, Japan, 1975-2015.

Second primary cancer (SPC) is one of the most life-threatening late effects of childhood cancers. We investigated the incidence and survival outcomes of SPC in childhood cancer patients in Japan. Data were obtained from the population-based Osaka Cancer Registry. Individuals diagnosed with cancer at age 0-14 years during 1975-2014 and survived 2 months or longer were followed through December 2015. The risk of developing SPC was assessed with standardized incidence ratio (SIR), excess absolute risk (EAR, per 100,000 person-years), and cumulative incidence. Multivariable Poisson regression analysis was carried out to assess relative risks of SPC by treatment method. Survival analysis was undertaken using the Kaplan-Meier method. Of 7229 childhood cancer survivors, 101 (1.4%) developed SPC after a median of 11.6 years. Overall SIR was 5.0, which corresponded with 84.3 EAR. The cumulative incidence was 0.9%, 2.1%, and 3.4% at 10, 20, and 30 years, respectively. Among all SPCs, the type that contributed most to the overall burden was cancers in the central nervous system (EAR = 28.0) followed by digestive system (EAR = 15.1), thyroid (EAR = 8.3), and bones and joints (EAR = 7.8); median latency ranged from 2.0 years (lymphomas) to 26.6 years (skin cancers). Patients treated with radiotherapy alone were at a 2.58-fold increased risk of developing SPC compared to those who received neither chemotherapy nor radiotherapy. Among patients who developed SPCs, 5-year and 10-year survival probabilities after SPC diagnosis were 61.7% and 52.0%, respectively. Risk-based long-term follow-up planning is essential to inform survivorship care and help reduce the burden of SPCs in childhood cancer survivors.

Prevalence and denial of current tobacco product use: Combustible and heated tobacco products, Japan, 2022.

Monitoring tobacco use has become more complex with the proliferation of novel tobacco products, including heated tobacco products (HTPs). We assessed the latest prevalence and denial of tobacco product use in Japan, a major market for HTPs. 28,124 individuals aged 16-74 responded to a nationwide, internet-based, self-reported survey. Current (past-30-day) tobacco use was assessed for HTPs, cigarettes, non-cigarette combustible tobacco, and dual (combustible plus HTP) use. Denial of current tobacco use was determined when respondents reported past-30-day use of a specific tobacco product ("On how many days did you use [the respective products]?") but denied having used any tobacco ("Do you currently use tobacco?") in the past 30 days. Descriptive and multivariable analyses were weighted to account for the selectivity of the internet-based sample. In 2022, current tobacco use was 11.8 % (HTPs), 19.4 % (cigarettes), 3.6 % (non-cigarette combustible tobacco), and 6.8 % (dual use). Among past-30-day users of specific tobacco products (N = 6,343), 19.5 % denied current tobacco use including single-product users of HTPs (10.0 %), cigarettes (21.7 %), and non-cigarette combustible tobacco (53.3 %), and dual users (20.2 %). The likelihood of denying current tobacco use was lower among exclusive HTP users and dual users compared to exclusive cigarette smokers; the likelihood was higher among females, never/non-current drinkers, less-frequent tobacco users, and those not reporting tobacco dependence. HTP use remained high in Japan. One-fifth of past-30-day tobacco users denied having used any tobacco products in the past 30 days. Increasing the sensitivity of questions to assess tobacco use can mitigate nondisclosure of tobacco use status.

Attitudes toward COVID-19 vaccination during the state of emergency in Osaka, Japan.

BACKGROUND: COVID-19 vaccination for general population started on April 12, 2021, in Osaka, Japan. We investigated public attitudes toward vaccination and associated factors of vaccine hesitancy during the third state of emergency. METHODS: An internet-based, self-reported, cross-sectional survey was conducted in June 2021, using the smartphone health app for residents of Osaka aged ≥18 years. Respondents were asked about their attitudes toward COVID-19 vaccine. Responses "Don't want to receive vaccines" or "Don't know" were defined as vaccine hesitancy (vs. "Received [1st dose]", "Received [2nd dose]", or "Want to receive vaccines"). Multivariable Poisson regression analysis was conducted to examine the associations between hesitancy and population characteristics. RESULTS: 23,214 individuals (8,482 men & 14,732 women) were included in the analysis. Proportions that answered "Received (1st dose)", "Received (2nd dose)", "Want to receive vaccines", "Don't want to receive vaccines", "Don't know", and "Don't want to answer" were 14.6%, 3.8%, 70.6%, 4.3%, 6.1%, and 0.5% among men; and 11.3%, 6.0%, 64.9%, 6.2%, 11.0%, and 0.6% among women. Factors associated with vaccine hesitancy included being a woman (aPR = 1.33; 95%CI = 1.23-1.44), age 18-39 (aPR = 7.00; 95%CI = 6.01-8.17) and 40-64 years (aPR = 4.25; 95%CI = 3.71-4.88 vs. 65+ years), living alone (aPR = 1.19; 95%CI = 1.08-1.30 vs. living with 3+ members), non-full-time employment and unemployment (aPRs ranged 1.12 to 1.49 vs. full-time employment), cardiovascular diseases/hypertension (aPR = 0.72; 95%CI = 0.65-0.81), and pregnancy (women of reproductive age only) (aPR = 1.35; 95%CI = 1.03-1.76). CONCLUSIONS: Most respondents expressed favorable attitudes toward COVID-19 vaccination while hesitancy was disproportionately high in certain populations. Efforts are needed to ensure accessible vaccine information resources and healthcare services.

Association of combustible and non-combustible tobacco use with clinically diagnosed adverse oral health outcomes among US adults, National Health and Nutrition Examination Survey (2009-2014).

INTRODUCTION: There is an established link between tobacco use and adverse oral health outcomes. However, there is a paucity of research exploring the effect of various tobacco products on clinically diagnosed adverse oral health outcomes. METHODS: Data were pooled from three cycles of the National Health and Nutrition Examination Survey: 2009-2010; 2011-2012; and 2013-2014 (n = 11,453). Multivariable logistic regressions examined the associations between periodontitis and dental caries with the type of tobacco product used (combustible, non-combustible or both). RESULTS: Overall, 42.3% of the study sample had any periodontitis, 7.8% had severe periodontitis and 21.7% had dental caries. There was a higher prevalence of periodontitis and caries among combustible tobacco users than non-combustible tobacco use; 62.1% of combustible tobacco smokers had any periodontitis, 17.1% had severe periodontitis, while 39.4% of adults with dental caries were dual users. Compared to non-smokers, combustible tobacco use increased the odds of any periodontitis (adjusted odds ratio [aOR] 2.81, 95% confidence interval [CI] 2.28, 3.45) and severe periodontitis (aOR 2.62, 95% CI 1.90, 3.61). Compared to non-smokers, both combustible tobacco (aOR 2.11, 95% CI 1.61, 2.76) and non-combustible tobacco use (aOR 2.09, 95% CI 1.19, 3.66) increased the odds of dental caries. DISCUSSION AND CONCLUSIONS: In this study of US adults, combustible tobacco use was associated with periodontitis and dental caries, while non-combustible tobacco use was associated with dental caries. In addition to conducting extensive oral health screening among all smokers, oral health-care providers should counsel smokers on the need for smoking cessation.

20-Year Trends in Tobacco Sales and Self-Reported Tobacco Use in the United States, 2000-2020.

INTRODUCTION: In the past 2 decades, many tobacco control policies were enacted, and several new or modified products were introduced into the US marketplace. Continued tobacco surveillance is critical in this evolving landscape. We examined 20-year trends in tobacco use from sales and self-reported data. METHODS: We obtained data on taxable removals (sales) of cigarettes, cigars, roll-your-own (RYO) tobacco, and pipe tobacco from the US Department of the Treasury. We assessed self-reported past 30-day tobacco use from the National Survey on Drug Use and Health among people aged 18 years or older. Volume sales were standardized to cigarette packs and cigarette pack equivalents (CPEs) and trends measured by using joinpoint and logistic regression. RESULTS: From 2000 to 2019-2020, declines occurred in per capita sales of cigarettes (101.01 to 42.29 packs/capita), little cigars (0.54 to 0.03 CPEs/capita), and RYO tobacco (1.34 to 0.21 CPEs/capita). Volume sales also decreased for chewing tobacco and scotch/dry snuff (all P < .05). Conversely, volume sales increased for pipe tobacco, moist snuff, and snus for the respective assessed periods. Large cigar volume sales did not change significantly. We found consistent trends in self-reported use, except for RYO tobacco (decreased volume sales but increased self-reported use) and pipe smoking (increased volume sales, but trivial self-reported use <1% throughout the study period). Current use of any tobacco product decreased from 32.2% to 22.9% during the assessed period. CONCLUSION: Harmonizing the tax and regulatory structure within and across the diversity of tobacco products may help reduce aggregate tobacco consumption in the US.

Manual route modification using an oblique method following automatic virtual bronchoscopic navigation.

ABSTRACT: Virtual automatic bronchoscopic navigation (VBN) systems to determine the route to peripheral pulmonary lesions (PPLs) in lung cancer can improve diagnostic biopsy yields. However, compared with VBN, drawing manual routes using computed tomography images, especially with oblique methods, can identify more routes. The Ziostation2 VBN system combines the benefits of these 2 methods; we evaluated this performance by comparing 3 different route-determining methods.We retrospectively collected data from 50 patients with PPLs measuring <30 mm who underwent transbronchial biopsy with an ultrathin bronchoscope at the Osaka International Cancer Institute during January to December 2018. We compared automatic VBN (Ziostation2), manual route modification using an oblique method after automatic VBN, and manual navigation using a general application computed tomography viewer. Concordance between predicted and actual branching were determined. We also compared the predicted relationship between the terminal bronchi and the lesion by 2 of the methods with ultrasonographic images (radial-probe endobronchial ultrasonography [radial-EBUS]).Manual modification after automatic VBN significantly increased the rate of determining routes to the target (66%) versus with the automatic VBN alone (32%) (P < .001). Expected route bifurcations were exact matches with actual branching in 45/48 of the patients using manual modification after automatic VBN. The predicted relationship between the terminal bronchi and the lesion using manual modification after VBN matched the radial-EBUS images in 35/50 of the patients.Manual modification of routes to PPLs using an oblique method after automatic VBN predicted actual radial-EBUS route imaging and could help determine appropriate patients for bronchoscopy.

Surgical volume threshold to improve 3-year survival in designated cancer care hospitals in 2004-2012 in Japan.

In Japan, cancer care hospitals designated by the national government have a surgical volume requirement of 400 annually, which is not necessarily defined based on patient outcomes. This study aimed to estimate surgical volume thresholds that ensure optimal 3-year survival for three periods. In total, 186 965 patients who had undergone surgery for solid cancers in 66 designated cancer care hospitals in Osaka between 2004 and 2012 were examined using data from a population-based cancer registry. These hospitals were categorized by the annual surgical volume of each 50 surgeries (eg, 0-49, 50-99, and so on). Using multivariable Cox proportional hazard regression, we estimated the adjusted 3-year survival probability per surgical volume category for 2004-2006, 2007-2009, and 2010-2012. Using the joinpoint regression model that computes inflection points in a linear relationship, we estimated the points at which the trend of the association between surgical volume and survival probability changes, defining them as surgical volume thresholds. The adjusted 3-year survival ranges were 71.7%-90.0%, 68.2%-90.0%, and 79.2%-90.3% in 2004-2006, 2007-2009, and 2010-2012, respectively. The surgical volume thresholds were identified at 100-149 in 2004-2006 and 2007-2009 and 200-249 in 2010-2012. The extents of change in the adjusted 3-year survival probability per increase of 50 surgical volumes were +4.00%, +6.88%, and +1.79% points until the threshold and +0.41%, +0.30%, and +0.11% points after the threshold in 2004-2006, 2007-2009, and 2010-2012, respectively. The existing surgical volume requirements met our estimated thresholds. Surgical volume thresholds based on the association with patient survival may be used as a reference to validate the surgical volume requirement.

Economic Hardships and Self-reported Deterioration of Physical and Mental Health Under the COVID-19 Pandemic: A Cross-sectional Study, 2020, Japan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has disproportionately affected the most vulnerable populations. We assessed the prevalence and disparities of economic hardships and their impact on health deterioration in Japan. METHODS: Data were obtained from a nation-wide, cross-sectional, internet-based, self-reported survey conducted during August-September, 2020 with individuals aged 15-79 years in Japan (n = 25,482). Economic hardships and changes in various physical and mental health status were measured using sample-weighted data. Adjusted prevalence ratios (APRs) were estimated to investigate the associations between economic hardships and health outcomes. RESULTS: During April-September, 2020 in Japan, 25.0%, 9.6%, 7.9%, and 3.1% of the respondents experienced income loss, money shortage, financial anxiety and financial exploitation, respectively, with higher prevalence among workers (vs non-workers). Stratifying by sex and working status, income loss was associated with physical health deterioration (APRs ranged from 1.45-1.95), mental health deterioration (APRs ranged from 1.47-1.68), and having serious psychological distress (APRs ranged from 1.41-2.01) across all strata. Shortage of money and financial anxiety were also associated with increased likelihood of all adverse health outcomes assessed, regardless of whether the hardships were pre-existing or experienced first time. Among non-working individuals, financial exploitation was associated with physical health deterioration among males (APR 1.88) and mental health deterioration among both males (APR 1.80) and females (APR 2.23), while such associations were not observed among working individuals. CONCLUSIONS: During the early phase of the COVID-19 epidemic, COVID-19-related economic hardships were associated with physical and mental health deterioration in Japan, particularly among the vulnerable populations. Timely and prompt responses are warranted to mitigate both economic and health burdens.

Incidence and relative risk of metachronous second primary cancers for 16 cancer sites, Osaka, Japan, 2000-2015: Population-based analysis.

BACKGROUND: An increasing number of cancer survivors have developed multiple primaries. This study aims to describe the incidence and risk patterns of metachronous second primary cancers (SPCs) in Osaka, Japan. METHODS: Data were obtained from the Osaka Cancer Registry, a population-based database of all cancers diagnosed in Osaka. The study subjects were individuals who were first diagnosed with invasive cancers in 16 major cancer sites during 2000-2014, aged 15-79 years, survived at least 3 months, and were followed up for 10 years. We measured incidence rates, cumulative risks, and standardized incidence ratios (SIRs: with the Osaka general population as the referent) of developing SPCs during 3 months to 10 years after the first diagnosis. RESULTS: During 2000-2015, among 418,791 cancer survivors, 24,368 (5.8%) developed SPCs within 10 years of first diagnosis. Males had higher incidence rates than females except among young-onset survivors (aged 15-39 years). 10-year cumulative risks among survivors aged 70-79 years (the most dominant age group) were 24.0% (male) and 11.8% (female). 10-year SIRs were 1.38 (95% CI, 1.36-1.40; male) and 1.44 (95% CI, 1.41-1.48; female) with higher estimates among younger survivors in both sexes. Strong bidirectional associations were observed between oral/pharyngeal, esophageal, and laryngeal cancers. Survivors of any smoking-related cancers had elevated SIRs of developing smoking-related SPCs. Similar results were observed for alcohol-related cancers. CONCLUSIONS: Cancer survivors are at excess risk of developing SPCs compared to the general population. Continued surveillance is warranted to inform survivorship care through risk-based long-term care planning and lifestyle-changing efforts to prevent new cancers.

Prevalence of heated tobacco product use in Japan: the 2020 JASTIS study.

BACKGROUND: Japan is the leading market for heated tobacco products (HTPs). We assessed the latest prevalence of HTP use including novel products (Ploom S, glo sens, and Pulze). METHODS: Data were obtained from an internet-based, self-reported survey conducted during February-March 2020 with individuals aged 15-74 years in Japan(n=9044). Prevalence of current (past 30-day) HTP use and cigarette smoking was computed. Poison regression analysis was conducted to examine predictors of HTP use among current cigarette smokers (n=1478). All analyses were weighted to account for selection bias in the internet survey using a nationally representative sample of Japanese population. RESULTS: In 2020, prevalence of current HTP use and cigarette smoking was 10.9% and 25.9% in Japan, respectively. The most commonly used HTP brand was IQOS (5.7%) followed by Ploom TECH/Ploom TECH+ (5.4%) and glo (2.6%). Use of Ploom S, glo sens and Pulze was 1.6%, 0.8% and 0.6%, respectively. Among current cigarette smokers, 34.9% of those who were interested in quitting smoking and 30.5% of those who were not interested in quitting reported concurrent use of HTP, respectively (difference not significant). Cigarette smokers who reported having multiple chronic conditions (aPR=2.31), alcohol consumption (aPR=2.07), and e-cigarette use (aPR=1.88) were more likely to use an HTP compared to those who did not report such characteristics. CONCLUSIONS: HTP use remained prevalent in Japan. One in three current cigarette smokers used HTPs regardless of whether they were interested inquitting smoking. Continuedsurveillance is important to inform national and global tobaccocontrol strategies.